Medicare Part B covers Dexcom G7 for people with diabetes who meet specific requirements

Yes, Medicare Part B covers the Dexcom G7 continuous glucose monitor, but not for everyone with diabetes. You must use insulin, either through injections or a pump, to may have access to. Medicare also requires that you have tried finger-stick testing (the traditional blood sugar check) or another glucose monitoring method first, or that your doctor documents why you cannot use those methods. The coverage includes the sensor itself, the transmitter, and the receiver device.

The amount you pay depends on whether you have Original Medicare alone or if you have added a Medigap or Medicare Advantage plan. With Original Medicare, you typically pay 20 percent of the approved amount after you meet your Part B deductible. The exact cost varies by location and supplier, so calling your Medicare-approved Dexcom supplier before ordering is the only way to know your out-of-pocket price.

Key Takeaways

  • Medicare Part B covers Dexcom G7 only if you use insulin and meet your doctor's documentation requirements.
  • You pay 20 percent of the Medicare-approved amount after your Part B deductible with Original Medicare.
  • You must order through a Medicare-approved Dexcom supplier, not directly from Dexcom's website.
  • Your doctor must write an order that includes specific information about your insulin use and why continuous monitoring is medically necessary.
  • Coverage includes the sensor, transmitter, and receiver, with sensors typically replaced every 10 days.

What your doctor needs to document for coverage

Your doctor must submit a written order to your Medicare-approved supplier that states you use insulin and explains why continuous glucose monitoring is medically necessary for you. This is not a complicated process, but it does require your doctor to take the step — Medicare will not cover Dexcom G7 based on your own request alone.

If you have already tried finger-stick testing or another glucose monitoring method, your doctor can note that in the order. If you cannot use those methods for a medical reason (for example, severe arthritis that makes finger sticks difficult), your doctor documents that instead. The order also needs to include your diabetes type and how often you check your blood sugar currently.

Call your doctor's office and ask them to submit a Dexcom G7 order to Medicare. Provide them with the name and contact information of the Medicare-approved supplier you plan to use — this helps the office send the order to the right place. Most offices can complete this within a few business days.

How to order through a Medicare-approved supplier

You cannot order Dexcom G7 directly from Dexcom's consumer website if you want Medicare to pay. Instead, you must use a Medicare-approved durable medical equipment (DME) supplier. These are companies that Medicare has vetted to dispense glucose monitors and supplies.

To find a supplier near you, call Medicare at 1-800-MEDICARE (1-800-633-4227) and ask for a list of Medicare-approved Dexcom suppliers in your area. You can also search the Medicare supplier directory online at dmepos.cms.gov. Once you have chosen a supplier, give their contact information to your doctor so the order goes to the right place.

The supplier will contact you once they receive your doctor's order. They will verify your Medicare coverage, tell you what you owe out of pocket, and arrange shipment of your first sensor and transmitter. Sensors arrive with instructions for setup, and most people can start using their first sensor within a few days of receiving it.

What happens after your first order

Once Medicare approves your initial Dexcom G7 order, you will need to reorder sensors regularly. Sensors last 10 days each, so you will typically need about three sensors per month. Your supplier can set up automatic shipments so you receive new sensors before your current one expires.

Medicare covers sensor replacements as long as your doctor's order remains valid. Most orders are good for one year, after which your doctor may need to submit a new order if you continue using the device. Your supplier will remind you when a new order is needed.

If your insurance situation changes — for example, if you switch to a Medicare Advantage plan — tell your supplier right away. Some Medicare Advantage plans cover Dexcom G7 under different rules, and your supplier needs to know which plan is primary to bill correctly.

Medicare Advantage plans and Dexcom G7

If you have a Medicare Advantage plan instead of Original Medicare, coverage for Dexcom G7 varies by plan. Some Medicare Advantage plans cover it with the same requirements as Original Medicare (insulin use, doctor's order). Others may have different rules, such as requiring you to try other glucose monitors first, or they may not cover it at all.

Call your Medicare Advantage plan's customer service number (on the back of your insurance card) and ask specifically whether Dexcom G7 is covered and what your out-of-pocket cost would be. Ask whether you need prior approval from the plan before ordering. Some plans require what is called "prior authorization," meaning the plan must say yes before your supplier ships the device.

If your plan does not cover Dexcom G7, you have the right to switch to Original Medicare during the annual open enrollment period (October 15 to December 7 each year). If you are newly may be able to access for Medicare or newly diagnosed with diabetes, you may have a special enrollment period that lets you switch outside the normal window.

Costs you should expect

With Original Medicare, your out-of-pocket cost for Dexcom G7 depends on whether you have met your Part B deductible for the year. The Part B deductible is the same for all Medicare beneficiaries, though it changes each year. Once you meet the deductible, you pay 20 percent of what Medicare approves for the sensor and transmitter.

The Medicare-approved amount for Dexcom G7 varies slightly by geographic region and supplier, but typically ranges from $300 to $400 per sensor. Your 20 percent share would be roughly $60 to $80 per sensor. Since you need about three sensors per month, your monthly out-of-pocket cost after the deductible is usually between $180 and $240.

If you have a Medigap plan, it may cover some or all of your 20 percent coinsurance, which would lower your actual cost. If you have a Medicare Advantage plan, your costs depend entirely on that plan's structure — some have copays per sensor, others have coinsurance, and some may have an annual out-of-pocket maximum that limits your total spending.

What to do if Medicare denies your request

If your supplier tells you that Medicare denied coverage, ask them to provide the reason in writing. Common reasons for denial include: your doctor's order did not include documentation that you use insulin, your plan determined that continuous monitoring is not medically necessary for your situation, or your supplier was not properly enrolled as a Medicare provider.

If the denial seems wrong, you have the right to ask Medicare to reconsider. This is called filing an appeal. Your supplier can help you understand the denial and may be able to resubmit the order with additional information from your doctor. If you believe the denial is unfair, you can also contact your State Health Insurance information Program (SHIP), which offers free help with Medicare questions and disputes. Find your state's SHIP at shiptalk.org.

Frequently Asked Questions

Do I have to use a specific brand of continuous glucose monitor, or will Medicare cover other brands?

Medicare covers Dexcom G6 and Dexcom G7, as well as the FreeStyle Libre 2 and Medtronic Guardian systems. Each has slightly different requirements. If your doctor prescribes a different brand, ask your supplier whether Medicare covers it before you order. Some brands may require different documentation or have different insulin-use requirements.

What if I use a insulin pump instead of injections?

Yes, insulin pump use counts as insulin use for Medicare coverage purposes. Your doctor's order should mention that you use a pump. Some pumps can connect directly to Dexcom G7 to share glucose readings, which can be helpful for managing your diabetes, though Medicare covers the Dexcom device itself regardless of whether it connects to your pump.

Can I use my Dexcom G7 with my smartphone instead of the receiver?

The Dexcom G7 app works on most smartphones, and many people use their phone instead of the receiver device. Medicare covers the sensor and transmitter, which are the parts that do the actual glucose monitoring. Whether you use the receiver or your phone to read the data does not change your Medicare coverage or your out-of-pocket cost.

What happens if I travel outside the United States?

Dexcom G7 works in many countries, but Medicare only covers it within the United States. If you travel internationally, you can continue using your device, but Medicare will not pay for sensors you use outside U.S. borders. Plan ahead and bring extra sensors if you are traveling for an extended period.

Do I need to switch suppliers if I move to a different state?

You may need to switch suppliers if your current supplier does not serve your new state. Call your current supplier first to ask whether they can continue shipping to your new address. If not, use the Medicare supplier directory to find a new Medicare-approved Dexcom supplier in your new state, and ask your doctor to submit a new order to that supplier.